Use and outcomes from neoadjuvant chemotherapy in borderline resectable pancreatic ductal adenocarcinoma in an Australasian population

Walpole, I; Lee, B; Shapiro, J; Thomson, B; Lipton, L; Ananda, S; Usatoff, V; McLachlan, SA; Knowles, B; Fox, A; Wong, R; Cooray, P; Burge, M; Clarke, K; Pattison, S; Nikfarjam, M; Tebbutt, N; Harris, M; Nagrial, A; Zielinski, R; Chee, CE; Gibbs, P

Author(s): Walpole, I; Lee, B; Shapiro, J; Thomson, B; Lipton, L; Ananda, S; Usatoff, V; McLachlan, SA; Knowles, B; Fox, A; Wong, R; Cooray, P; Burge, M; Clarke, K; Pattison, S; Nikfarjam, M; Tebbutt, N; Harris, M; Nagrial, A; Zielinski, R; Chee, CE; Gibbs, P;
Details: Publication Year 2023-02,Volume 19,Issue #1,Page 214-225
Journal Title: Asia-Pacific Journal of Clinical Oncology
Publication Type: Research article
Abstract: BACKGROUND: Use of neoadjuvant (NA) chemotherapy is recommended when pancreatic ductal adenocarcinoma (PDAC) is borderline resectable METHOD: A retrospective analysis of consecutive patients with localized PDAC between January 2016 and March 2019 within the Australasian Pancreatic Cancer Registry (PURPLE, Pancreatic cancer: Understanding Routine Practice and Lifting End results) was performed. Clinicopathological characteristics, treatment, and outcome were analyzed. Overall survival (OS) comparison was performed using log-rank model and Kaplan-Meier analysis. RESULTS: The PURPLE database included 754 cases with localised PDAC, including 148 (20%) cases with borderline resectable pancreatic cancer (BRPC). Of the 148 BRPC patients, 44 (30%) underwent immediate surgery, 80 (54%) received NA chemotherapy, and 24 (16%) were inoperable. The median age of NA therapy patients was 63 years and FOLFIRINOX (53%) was more often used as NA therapy than gemcitabine/nab-paclitaxel (31%). Patients who received FOLFIRINOX were younger than those who received gemcitabine/nab-paclitaxel (60 years vs. 67 years, p = .01). Surgery was performed in 54% (43 of 80) of BRPC patients receiving NA chemotherapy, with 53% (16 of 30) achieving R0 resections. BRPC patients undergoing surgery had a median OS of 30 months, and 38% (9 of 24) achieved R0 resection. NA chemotherapy patients had a median OS of 20 months, improving to 24 months versus 10 months for patients receiving FOLFIRINOX compared to gemcitabine/nab-paclitaxel (Hazard Ratio (HR) .3, p < .0001). CONCLUSIONS: NA chemotherapy use in BRPC is increasing in Australia. One half of patients receiving NA chemotherapy proceed to curative resection, with 53% achieving R0 resections. Patients receiving Infusional 5-flurouracil, Irinotecan and Oxaliplatin (FOLIRINOX) had increased survival than gemcitabine/nab-paclitaxel. Treatment strategies are being explored in the MASTERPLAN and DYNAMIC-Pancreas trials.
Publisher: Wiley
Keywords: Humans; Middle Aged; *Pancreatic Neoplasms/drug therapy/surgery/pathology; Neoadjuvant Therapy/methods; Antineoplastic Combined Chemotherapy Protocols/adverse effects; Gemcitabine; Retrospective Studies; Deoxycytidine; Fluorouracil; *Carcinoma, Pancreatic Ductal/drug therapy/surgery/pathology; Leucovorin; drug therapy; general surgery; mortality; neoadjuvant therapy; pancreatic neoplasms
Department(s): Medical Oncology
PubMed ID: 35831999
Publisher's Version: https://doi.org/10.1111/ajco.13807
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2023-06-15 07:24:52

Last Modified: 2023-06-15 07:25:48